ATA/628/1998•No nondisclosure for renal-stone reserve
ATA/628/1998Tribunal de Justiça / Câmara Administrativa6 de out. de 1998Granted
Extraído pela Omnilex
The court held that an overnight hospitalization for a prostate condition was irrelevant to the insurer’s assessment of whether it could reserve coverage for renal lithiasis. The insured’s statement that he did not suffer from urinary-tract disease was therefore not a nondisclosure. The appeal was allowed and the reservation could not be maintained.
LAMA 12; duty of disclosure in health insurance and reservation for a later-affecting condition; a fact is relevant only if it is materially connected with the risk to be assessed. A transient prostate problem requiring brief hospitalization is not, by itself, pertinent to the imposition of a reservation for renal lithiasis. Where the insured states that he does not suffer from urinary-tract disease, no concealment is committed if the undisclosed circumstance is not objectively relevant to the insured risk (consid. unknown).
Descripteurs
ASSURANCE SOCIALE; AM; VIOLATION DE L'OBLIGATION D'ANNONCER; ASSU/LCA
Normes
LAMA.12
Résumé
L'existence d'un problème de prostate ayant entraîné une hospitalisation d'une nuit n'est pas pertinente pour déterminer si la caisse peut imposer à l'assuré une réserve pour l'affection de lithiase rénale. En indiquant qu'il ne souffrait pas de maladie des voies urinaires, le recourant n'a pas commis de réticence.
Extraído pela Omnilex
Whether a one-night hospitalization for a prostate problem justified a reservation for renal lithiasis.
No. The prostate episode was not relevant to assessing whether the insurer could impose a reservation for renal lithiasis.
The prior prostate problem did not amount to a fact materially connected to the later risk assessment for kidney stones.
Whether the insured committed concealment by stating that he did not suffer from urinary-tract disease.
No. That statement was not false in the circumstances and did not constitute nondisclosure.
Because the prostate issue was not pertinent to urinary-tract disease for the purpose of the insurance declaration, the insured had not breached the duty of disclosure.
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